Chest pain, sinus tachycardia, and ST Elevation

I was reading through ECGs on the system when I saw this one:Sinus tachycardia, rate 120Computerized QTc = 380 msWhat do you think? I was immediately worried about a proximal LAD occlusion.  Although sinus tachycardia generally argues against ACS, a large anterior MI may result in such poor stroke volume that there is compensatory tachycardia and possibly impending cardiogenic shock. I looked to see if there was an ED cardiac ultrasound, and there was:Parasternal Long Axis:Poor image, but one can see that there is poor apical functionParasternal short axis:This shows poor contractility of the anterior wall.Contrast the shortening and thickening of the posterior wall (opposite the transducer) to the anterior wall (closest to the transducer)Apical 4 chamber:Apical wall motion abnormalityThe base is contracting well.At this point I still knew nothing about the patient, but was worried about an acute anterolateral STEMI (Proximal LAD occlusion).I went to talk with the treating clinicians.  They too were worried about LAD occlusion and had consulted cardiology.Here is the history:An elderly woman with history of diabetes and hypertension presented ambulatory with acute onset of crushing 10/10 chest pain that radiates to the back.  It started one hour prior to arrival.  She has never had anything like this before.With that history, I had no doubt about the diagnosis.Cardiology performed a formal echo.  Here is the result.  (She had previous n...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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Publication date: Available online 25 January 2020Source: Clinics and Research in Hepatology and GastroenterologyAuthor(s): Wen-Yi Liu, Jian-Hong Wang, Yuan Guo, Xin Wang, Xiao-Dong Wu, Chuan-Shen Xu, Yang Zhao, Yun-Jin ZangSummaryBackgroundAn objective and accurate evaluation of liver grafts is required to improve the prognosis of liver transplant recipients and to increase the number of available liver grafts.AimTo compare outcomes using FibroScan with that of pathology in liver grafts from brain-dead donors (DBD).MethodsLiver grafts from 52 DBD were examined using ultrasound (US), FibroScan before liver transplantation ...
Source: Clinics and Research in Hepatology and Gastroenterology - Category: Gastroenterology Source Type: research
Publication date: Available online 25 January 2020Source: British Journal of Oral and Maxillofacial SurgeryAuthor(s): H. Saghafi, P. Benington, A. AyoubAbstractThe aim of this study was to compare the impact that the orthodontics-first approach and the surgery-first approach have on quality of life, anxiety, and depression in patients treated for dentofacial deformities. Data were collected on 32 patients (aged 17–47 years) who were all treated at a single multidisciplinary orthognathic clinic. They completed a 22-item Orthognathic Quality of Life Questionnaire (OQLQ), a seven-item Generalised Anxiety Disorder (GAD-7...
Source: British Journal of Oral and Maxillofacial Surgery - Category: ENT & OMF Source Type: research
ConclusionCongenital piriform sinus fistula is an important cause of deep neck abscess in children. The presence of purulent gas-liquid equilibrium or air shadow in cervical-enhanced computed tomography or ultrasound suggests a high possibility of the presence of an internal fistula, and endoscopic low temperature ablation can be done at the same time as the diagnostic endoscopy.ResumoIntroduçãoA fístula congênita do seio piriforme é uma doença relativamente rara na prática clínica; a maioria se manifesta na infância; entretanto, os médicos geralmente t&ec...
Source: Brazilian Journal of Otorhinolaryngology - Category: ENT & OMF Source Type: research
ConclusionsPillar suture combined with tonsillectomy may reduce postoperative bleeding incidence despite increasing pillar edema in pediatric tonsillectomy. Postoperative pain-relief, palatal hematoma, palatal discomfort sensation, site infection, and velopharyngeal insufficiency were not significantly altered compared to tonsillectomy alone. However, further studies are needed to corroborate the results of this study.ResumoIntroduçãoDiversas técnicas cirúrgicas têm sido utilizadas na tonsilectomia no intuito de reduzir complicações.ObjetivosAvaliar os efeitos da sutura dos p...
Source: Brazilian Journal of Otorhinolaryngology - Category: ENT & OMF Source Type: research
ConclusionsIn conclusion, we identified a genetic regulator of spontaneous lipolysis, and provide evidence for HIF3A as a novel key regulator of lipolysis in subcutaneous adipoctyes as the mechanism through which the locus is influencing adipose tissue biology.
Source: Molecular Metabolism - Category: Endocrinology Source Type: research
Publication date: Available online 25 January 2020Source: Pharmacology &TherapeuticsAuthor(s): Yun-Feng LiAbstractMajor depressive disorder has become a global public health problem of serious concern. Most of the clinical antidepressants are developed under the classic “monoamine hypothesis (strategy)”. These drugs generally have such deficiencies including slow onset and limited efficiency, cognitive impairment and suicidal tendency. Therefore, it is the direction to break through the classic monoamine strategy framework for developing antidepressants that have fast-acting, lower side effects, and cogniti...
Source: Pharmacology and Therapeutics - Category: Drugs & Pharmacology Source Type: research
ConclusionP. karwinskii leaf extract inhibited reactive oxygen species and exerted an anti-inflammatory effect. Moreover, this extract did not induce gastric damage in the animals. The bioactivity of the species was found to support its traditional use in traditional medicine. This orchid could be used to treat inflammatory diseases without causing the side effects associated with Nonsteroidal anti-inflammatory drugs. It can also be employed to treat other pathological conditions associated with oxidative stress. The findings herein form the basis for the future discovery of natural products that may serve as safe alternat...
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
ConclusionsThe results suggested that KXS exerted antidepressant effects by regulating the signaling pathways involved in lipid metabolism disorders. The lipid metabolites might be potential biomarkers of depression and possible targets for KXS-based treatment of depression.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
Publication date: Available online 25 January 2020Source: International Journal of PharmaceuticsAuthor(s): Zaizhi Gui, Jinchang Zhu, Song Ye, Juan Ye, Jiao Chen, Yuanyuan Ling, Xueting Cai, Peng Cao, Zhiyu He, Chunping HuAbstractGating modifier toxins (GMTs) from animal venom have shown great potential in controlling blood glucose levels in type II diabetes (T2D), but their high acute toxicity and quick clearance in the body hamper their potential therapeutic use. Inspired by their highly positive charge, we have developed a nanocomplex system based on polyelectrolytes, in which strong interactions form between positively ...
Source: International Journal of Pharmaceutics - Category: Drugs & Pharmacology Source Type: research
ConclusionsCMR is a key tool for diagnosing LDAC. Characteristic findings are subepicardial fatty infiltration and midwall-subepicardial late gadolinium enhancement. The prognosis of this population is poor with a high incidence of sudden cardiac death and ventricular arrhythmias.ResumenIntroducción y objetivosRecientemente, la miocardiopatía arritmogénica del ventrículo izquierdo (MCAVI) ha sido reconocida como parte del espectro de la miocardiopatía arritmogénica. Se caracteriza por el reemplazo fibroadiposo de la pared de dicho ventrículo. Se describen las formas de prese...
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research
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